Delivering Biomedical Information Services In FY18, NLM greatly expanded the quantity and range of high quality information and data available to researchers, health professionals, and the public: PubMed: PubMed, which incorporates MEDLINE, is NLM's premier bibliographic database with over 28 million references to biomedical journal articles. MEDLINE articles are indexed by experts using the Medical Subject Headings (MeSH) controlled vocabulary, which is updated annually. In FY18 NLM indexed more than 850,000 new citations and added a total of 1,280,000 citations to PubMed. NLM continued to expand use of automated indexing technology to increase efficiency and began a 5-year initiative to explore novel approaches to automated indexing. PubMed Central (PMC): The PMC archive of over 5 million full-text journal articles is central to the effort to make published results of NIH-supported research publicly accessible. As of FY18, PMC also enables public access to published results of research supported by 10 other federal agencies, as well as private and international research funders. In FY18, NLM added half a million additional full-text articles to PMC. Additionally, in October 2017, NLM announced that it would accept deposits of small datasets accompanying funded author manuscripts submitted via the NIH Manuscript Submission system and issued guidance for PMC data providers on capturing data citations in a machine-readable way that facilitates discovery and re-use. MedlinePlus and MedlinePlus en espanol: These consumer health information resources now cover more than 1000 topics, with selected materials in more than 50 languages. In FY18 laboratory test information was added to MedlinePlus. MedlinePlus Connect links electronic health records to patient education information from MedlinePlus by leveraging standardized codes and vocabularies required for meaningful use. Clinical Trials: Clinicaltrials.gov contains information on more than 280,000 clinical research studies in more than 200 countries, with hundreds added weekly. It also contains summaries of study results, including adverse events information, in accordance with the FDA Amendments Act of 2007 (PL 110-85) and the implementing regulations (42 CFR Part 11). Over the last year, nearly 22,000 new trials were registered, and summary results for more than 4,200 trials were added, bringing the total of studies with results to more than 30,000. NLM staff continued assisting in implementing regulations and policy covering registration and results submission. Environmental Health and Toxicology: TOXNET is a primary reference for toxicologists, poison control centers, public health officials, physicians and environmental health professionals, and includes databases such as TOXLINE, Toxics Release Inventory, Hazardous Substances Data Bank, ToxMap and Haz-Map. The Household Products Database now contains health effects of chemicals from close to 20,000 products In FY18, an updated Toxicology Tutorial was released along with a newly redesigned Tox Town. Drug Information Resources: These include Drug Information Portal, DailyMed, Pillbox, LiverTox, and LactMed. The Portal provides information on drugs from clinical trial to the marketplace. DailyMed provides drug labeling information from package inserts for nearly 90,000 marketed drugs, with improved mobile access; Pillbox enables rapid identification of unknown solid-dosage medications based on physical characteristics and images. Both are linked to NLM's RxNorm standard drug names. LiverTox provides comprehensive clinical, diagnostic and research information and case registry on liver injury due to drugs, herbals and dietary supplements. LactMed is a database of the effects of over 1,300 drugs, dietary supplements, and diagnostic agents on breastfeeding mothers and their nursing infants and is now available in NCBI Books. Disaster and Public Health Emergency Preparedness and Response: NLM's Disaster Information Management Research Center (DIMRC) provides access to disaster information, promotes use of libraries in disaster preparedness and response, and supports uninterrupted access to critical health information resources when disasters and public health emergencies occur. DIMRC produces WISER, CHEMM, and REMM, emergency responder tools for hazardous materials and chemical, biological, radiological, and nuclear incidents. In FY18, NLM released a new design for the DIMRC website and the Disaster Lit database, a resource covering non-journal literature on disasters and public health emergencies. Molecular Biology, Bioinformatics, Genetics, and Human Genome Resources: NCBI resources include more than 40 integrated molecular biology databases and bioinformatics software tools such as GenBank, Entrez, BLAST, RefSeq, dbGAP, Genomes, PubChem, Genetic Testing Registry, Conserved Domain Database, and ClinVar. Highlights during the year included the addition of 248 million new sequences to GenBank, and nearly 32 million sequence records to RefSeq (a 17% increase), and more than 100,000 human genome sequence variants to ClinVar. Continuing areas of emphasis include addressing the impact of enormous quantities of data from high throughput sequencing and microarrays; organizing phenotypic and genotypic data from genome-wide association studies; and enhancing interfaces to journal literature retrieval to facilitate search and discovery. In collaboration with CDC, FDA, and USDA, NCBI is using high throughput sequencing to more rapidly and accurately identify pathogens causing foodborne illnesses; similar technology is being applied to develop resources to combat antimicrobial resistance. In FY18 the Pathogen Detection pipeline processed genome sequence data for about 90,000 food, factory, farm and other samples to identify human pathogens such as Salmonella, E. coli/Shigella, Campylobacter and Lysteria. Outreach Promoting Public Awareness and Access: NLM outreach programs, many achieved through the National Network of Libraries of Medicine, enhance awareness of NLMs information services through hundreds of library and community-based activities funded annually. In FY18, the Network trained over 400 public library staff, developed summer reading program materials for 16,000 public libraries, and launched a Wikipedia campaign. Health Services Research: NICHSR promotes access to public health and health services research information. ONESearch was introduced in FY18, offering a uniform interface to the databases HSRProj (covering over 35,000 health services research projects in-progress from over 380 funding sources), HSRR (for research datasets, instruments and software relevant to health services research), and the PHPartners and HSRInfo_Central web portals. Structured search queries are developed to aid in searching PubMed for published research on topics such as comparative effectiveness, population health, health disparities, and Healthy People 2020 objectives. Health Data Standards: As the HHS central coordinating body for clinical terminology standards, NLM provides essential tools for interoperability of electronic health records (EHRs) and health information systems. The AccessGUDID database that links FDA and SNOMED codes for medical devices was augmented for over 260,000 implantable devices in support of a 2018 requirement for certified EHRs, and the SNOMED CT to ICD10CM map was updated in the IMagic (Interactive MapAssisted Generation of ICD Codes) tool that supports interoperability and quality assurance in EHRs. The Value Set Authority Center (VSAC) deepened support of CMS clinical quality measures, and the NIH Common Data Element Repository was augmented with tools and content to facilitate data sharing, aggregation, collaboration, comparison, and usability improvements.